question

Medicare benefits are available to individuals under

answer

One of six beneficiary categories

question

Disabled adults may be eligible for

answer

Medicare benefits

question

Hospital benefits are provided by

answer

Medicare Part A

question

Outpatient hospital benefits are provided by

answer

Medicare part B

question

Hospice benefits are provided by

answer

Medicare part A

question

Home Healthcare is provided by

answer

Medicare part A

question

Skilled Nursing Care is provided by

answer

Medicare part A

question

The coinsurance for Medicare Part B is

answer

20 percenf

question

Medicare Part B is also called

answer

Supplemental Medical Insurance

question

Durable Medical Equipment is covered by

answer

Medicare Part B

question

Medicare Part A is administered by

answer

CMS

question

The prescription drug plan is offered by

answer

Medicare Part D

question

Medicare Advantage is part of

answer

Medicare Part C

question

Each Medicare enrollee receives a Medicare card issued by the

answer

Social Security Administration

question

IPPE is the abbreviation for

answer

Initial preventive physical examination

question

AWV is the abbreviation for

answer

Annual wellness visit

question

In cases when immunizations are covered, they are covered by

answer

Medicare Part B

question

Medicare does not provide benefits for

answer

Cosmetic surgery

question

Physicians who participate in the Medicare Program must accept

answer

Assignment and file claims for beneficiaries

question

MACs are paid to process claims for

answer

Government medical insurance programs

question

ABN is the abbreviation for

answer

Advance beneficiary notification

question

NCD stands for

answer

National coverage determination

question

LCD is the abbreviation for

answer

Local coverage determination

question

LCDs are coverage decisions that help providers

answer

Determine medical necessity under Medicare

question

The Medicare limiting charge is the

answer

Highest fee that can be charged for a procedure by nonparticipating provider

question

The Medicare program employs MACs to pay the claims

answer

Submitted by providers

question

Medicare beneficiaries can select from a traditional

answer

Fee for service or managed care

question

Medicare beneficiaries receive a MSN (Medical summary notice), which is an

answer

Explanation of Medicare benefits

question

MSA is the abbreviation for

answer

Medicare medical savings account

question

MAO is the abbreviation for

answer

Medicare advantage organization

question

Urgently needed care is defined in the Medicare program as

answer

Unexpected illness or injury that requires immediate treatment

question

CCP is the abbreviation for

answer

Medicare coordinated care plans

question

A Medigap insurance plan is an insurance offered by

answer

Private insurance carrier

question

Supplemental insurance plans for Medicare beneficiaries provide

answer

Additional coverage for an individual receiving benefits under Medicare Part B

question

CCI is the abbreviation for

answer

Medicare's correct coding initiative

question

OIG is the abbreviation for

answer

Office of the inspector general

question

Roster billing applies to

answer

Medicare Part B

question

A duplicate claim is defined as those sent to one or more Medicare contractors from

answer

the same provider for the same beneficiary, the same service and the same date of service

question

Most Medicare claims are HIPAA 837P transactions and are transmitted

answer

Electronically

question

Both patients and providers have the right to

answer

Appeal denied Medicare claims

question

Anyone over age 65 who receives Social Security benefits is automatically enrolled in

answer

Medicare Part A and eligible to enroll in Part B

question

People who are over age 65 but who are not eligible for free Part A coverage may enroll by

answer

Paying a premium

question

Medicare Part A is also called

answer

Hospital Insurance

question

Medicare Part D provides voluntary Medicare

answer

Prescription drug plans

question

Medicare Part B is also called

answer

Supplementary medical insurance

question

115 percent of the fee on the Medicare NonPAR fee schedule equals the

answer

Limiting charge

question

Patients receive a Medicare Summary Notice (MSN) that details the

answer

Services they were provided over a 30 day period, the amounts charged, and the amounts they may be billed

question

FMAP is the abbreviation for

answer

Federal Medicaid assistance percentage

question

Medicaid beneficiaries must meet both

answer

Minimum federal requirements as well as any additional state requirements

question

A person eligible for Medicaid in a given state is not necessarily eligible in

answer

All states

question

Categorically needy people in the Medicaid program usually don't have

answer

High incomes

question

CHIP is the abbreviation for

answer

Children's health insurance program

question

TANF is the abbreviation for

answer

Temporary assistance for needy families

question

Individuals receiving financial assistance under TANF due to low incomes and few resources must be covered by

answer

State Medicaid programs

question

SSI is the abbreviation for

answer

Supplemental security income

question

Children under 6 years old who meet TANF requirements or whose family income is below 133 percent of the poverty level must be offered state

answer

Medicaid benefits

question

The EPSDT (early and periodic screening, diagnosis, and treatment) program of Medicaid covers

answer

Children under age 21

question

A burial plot is not considered an

answer

Asset

question

The medical insurance specialist should check patient's Medicaid eligibility each time

answer

An appointment is made

question

EMEVS stands dor

answer

Electronic Medicaid eligibility verification system

question

Medicaid is referred to as the

answer

Payer of last resort

question

Under the payer of last resort regulation, Medicaid pays last on a claim when a patient has

answer

Other effective insurance coverage

question

Dual eligibility refers to

answer

Medicaid and Medicare

question

Medicaid claims are usually submitted using the

answer

HIPAA 837P claim

question

The TANF program under Medicaid offers financial assistance for people with

answer

Low incomes and few resources

question

The federal government sends Medicaid funding to states under the

answer

FMAP profram

question

Medicaid is jointly funded by federal and

answer

State governments

question

Medicaid provides preventive services to children under age 21 under the

answer

ESPDT program

question

The CHIP program under Medicaid offers health insurance coverage for

answer

Uninsured children

question

Federal guidelines mandate coverage for individuals referred to as

answer

Categorically needy

question

All categories of peoples' assets except ownership of a home must be considered in determining

answer

Medicaid eligibility

question

People who receive income from employment may qualify for Medicaid depending on the

answer

Amount

question

In restricted status, the patient is required to see a

answer

Specific physician and/or use a specific pharmacy

question

Under a state's Medicaid program, cosmetic procedures may

answer

Not be covered

question

Many states have moved beneficiaries to

answer

Managed care plans

question

A physician who wishes to provide services to Medicaid recipients must

answer

Sign a contract with the department of health and human services (HHS)

question

Claims billed to Medicare which are automatically sent to Medicaid are caleld

answer

Crossover claims

question

Physicians who contract with Medicaid to provide services may not bill for services that are

answer

Not medically necessary, submit claims for individual procedures that are part of a global procedure, or bill for services not provided

question

The uniformed services member in a family qualified for TRICARE is called the

answer

Sponsor

question

TRICARE is the department of defense's health insurance plan for

answer

Military personnel and their families

question

Info about TRICARE patient eligibility is stored in the

answer

Defense enrollment eligibility reporting system (DEERS)

question

TRICARE, which includes managed care options, replaced the program known as

answer

CHAMPUS

question

TRICARE brings the resources of military hospitals together with a network of civilian facilities and providers to offer

answer

Increased access to healthcare services

question

Providers may not contact DEERS directly because the info is protected by the

answer

Privacy Acy

question

All military treatment facilities, including hospitals and clinics, are part of the

answer

TRICARE system

question

The expiration date on an individual's military ID card should be checked to confirm that

answer

Coverage is still valid

question

TRICARE pays only for services rendered by

answer

Authorized providers

question

A provider who chooses not to participate may not charge more than

answer

115 percent of the allowable charge

question

Coat share is a TRICARE term for

answer

Coinsurance

question

TRICARE's fiscal year is from

answer

October 1 through September 30

question

Providers who choose not to join the TRICARE network may still provide care to managed care patients, but TRICARE will not pay for the

answer

Services, the patient is 100 percent responsible for the charges

question

The maximum amount TRICARE will pay for a procedure is known as the

answer

TRICARE Maximum Allowable Charge (TMAC)

question

The TRICARE program that offers fee for service coverage is

answer

TRICARE Standard

question

The TRICARE program that offers an HMO- like plan requiring no annual deductible is

answer

TRICARE Prime

question

The TRICARE program that offers an alternative managed care plan to TRICARE Prime with no annual enrollment fee is

answer

TRICARE Extra

question

The TRICARE program that offers benefits to active duty reservists is

answer

TRICARE Reserve Select

question

After enrolling in TRICARE Prime, individuals are assigned a Primary Care Manager (PCM) who

answer

Coordinates and manages their medical care

question

Retirees and their families, former spouses, and families of deceased personnel pay a

answer

25 percent cost share for outpatient services

question

A catchment area is a

answer

Geographic area served by a hospital, clinic, or dental clinic

question

Under TRICARE Prime, there is no deductible, and no

answer

Payment is required for outpatient treatment at a military facility

question

The TRICARE program that offers benefits to Medicare-eligible military retirees and family members is

answer

TRICARE for Life

question

Medi-medi beneficiaries is an individual who is eligible for both

answer

Medicare and Medicaid

question

TRICARE for Life offers the opportunity to receive healthcare at a military treatment facility to individuals age

answer

65 and over who are eligible for both Medicare and TRICARE

question

Benefits are similar to those of a Medicare HMO, with an emphasis on preventive and wellness services; prescription drug benefits are also included in

answer

TRICARE for Life

question

All enrollees in TRICARE for Life must be enrolled in

answer

Medicare parts A and B and pay Part B premiums

question

Treatment at a civilian network facility requires a copay for

answer

TRICARE for Life beneficiaries

question

Best practice for filing paper claims is to check with each payer for

answer

Specific information required on the form

Medical Insurance Ch. 9,10,11 review: Overview – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards